Fractures of the ankle are commonly a result of a rotational injury, a mechanism similar to when the foot rolls out during an ankle sprain. Ankle fractures often require surgery to replace the fractured pieces to normal anatomic alignment and ensure that the ankle joint is in correct position. Ankle fractures that don’t have gapping or angulations/rotation at the fracture site are usually treated with casting, and don’t require surgery. It is essential to align the ankle fracture to within 2 millimeters of original position for optimal long term results. Ankle fractures involve the joint cartilage can lead to arthritis in the ankle joint. It is especially important that ankle fractures are reduced to return the anatomy to its normal position and alignment.